Introduction
Organizational culture is a unique system of shared norms, values, and attitudes that are manifested in symbols, artifacts, and preferred values. It determines the behavior of employees in the organization and affects its functioning and performance. Creating an organizational culture is a never-ending process that is influenced by top managers, leaders of the organization (Čmelíková, Čmelík, 2012). According to Šoltys (2022), organizational culture is the source of the organization's strategic vision. It is a potential that serves to unite employees in achieving common goals. Hulková (2024) states that the organizational culture should be pleasant to maintain employee engagement. He perceives it as behavioral management, which significantly affects the success of any organization. On the one hand, it can be a carrier of competitive advantage and a source of strength, and on the other hand, it can also be an obstacle to the development of an organization and even a source of its destruction (Hulková, Meluš, 2023). Experts agree that every organizational culture of a given organization is represented by its elements. Kachaňáková (2010) included values, rituals, heroes and symbols among the basic elements. Values make it possible to distinguish the good from the bad, they express the organization's preferences. They are reflected in all work activities of employees. According to Zelna (2017), they help distinguish desirable behavior from undesirable behavior. Rituals are established patterns of behavior towards new employees in order to maintain them in the organization. According to Hulková and Meluš (2023), organizational culture significantly affects employee turnover. At the same time, it enables the creation of one's own identity and reduces the uncertainty of new employees (Ubrežiová, Sedláková, 2013). The role of heroes is to motivate employees towards behavior that is supported by the organization. Symbols, also called artifacts, are signs of what we can actually see or hear. By creating its own symbols, the organization can purposefully create the desired management culture. According to Suderman (2012), the type of organizational culture depends on its core values of the organization in combination with its vision.
Clan culture is a family-type organizational culture. Its sign is a positive organizational climate. The goal is for employees to perceive the organization as their family, on which they can rely and therefore are loyal to it. High priority is given to teamwork, trust, loyalty, belonging and support for employee education. According to Kancírová (2022), clan culture is characterized by shared values, goals, participation and a sense of belonging to organizations. This type of culture is often described as a type in which a pleasant environment for the performance of one's profession prevails and positive interpersonal relationships are created. Kürtiová (2016) characterizes it as an extended family, in which managers play the role of mentors and even "parents." The organization is united by loyalty and tradition.
Adhocratic culture is characterized by a turbulent environment. Innovations and solutions are the basic prerequisites for the success of this organizational culture. The role of managers is to support the business environment, creativity and innovation. They are considered a source of new visions, flexibility of employees. Great emphasis is placed on the ability to work in a constantly changing team. A fundamental belief in an adhocratic organizational culture is the principle that idealistic and innovative visions instill in employees a willingness to take risks and be creative (Chad, Amy Yi, Kinicki, 2011). According to Šoltys (2022), employees in this type of culture are courageous, flexible, innovative, take risks and thus find new solutions.
Hierarchical culture is also referred to as bureaucratic culture. It is suitable for an unchanging and permanent environment. In an organization where the decision-making line of the superiors is clearly established, there are precisely defined job positions and standardized rules. Employees work on the basis of fixed rules and work procedures that have proven themselves in the past (Cameron, Quinn, 2006). The key to the success of this model is strict control, reliable control mechanisms (Belko, 2012). Managers are good organizers and their goal is to achieve stability and efficiency.
Market culture. An organization with this type of management culture is oriented towards transactions with other organizations, suppliers, customers. The goal is to gain a competitive advantage. Typical signs for a market culture are clear economic results, profit, well-defined goals and ensuring a quality customer network. The main values are competitiveness and productivity. A hallmark of market management culture is an aggressive strategy that leads to results and profits. In achieving any goals, the main element is victory. Stovíček (2022) states that each type of organizational culture is considered ideal for a specific organization based on its characteristics. The type of organizational culture depends on the organizational structure of the given facility and its basic values associated with the vision and direction of the organization. It is common for several, at least two, types of organizational culture to exist in an organization at the same time.
Target
To identify the current and preferred type of organizational culture in selected hospitals.
File and Methodology
The file consisted of 168 nurses from one state health facility (n=75) and two non-state health facilities (n=93), coded as No. 1 (n=71) and No. 2 (n=22). 65 nurses had a first-level university education and experience in the nursing profession lasting from 6 to 15 years (38.7%). 23 nurses worked for 16 to 25 years (13.7%). 13 nurses had secondary education and more than 25 years of experience (7.7%). We collected data from May to June 2022 using the standardized Organizational Culture Assessment Instrument (OCAI) questionnaire method. We calculated the reliability of the questionnaire using Cronbach's α coefficient with an estimated 95% confidence interval (Cronbach, 1951). The resulting internal reliability values were calculated for the total dataset as well as for its 4 types of cultures (i) clan; (ii) adhocratic; (iii) market; (iv) hierarchical. We interpreted reliability according to Nunnaly (1978), i.e. the minimum coefficient limit for acceptable internal consistency is α = 0.7. All statistical calculations were performed in the programming language environment "R" version 3.6.1 (R Core Team, 2022) using the libraries "psych" version 2.0.12 (Revelle, 2020), "packHV" version 2.2 (Varet, 2019) and "coin" (Horthorn et al. 2008). The graphic outputs of the tests were edited in Inkscape (Harrington et al. 2004).
Results and Discussion
The data analysis (Tab.1) showed that the nurses in the state health facility evaluate the current organizational culture as hierarchical (35.1%; CI95% = 30.1–40.6) and clannish (26%; CI95% = 22.4–29.6), which they also prefer (29%; CI95% = 26.7–31.2). The principle of hierarchical culture is the "principle of order." It is focused on the values of managers, their ideas and expectations. When planning with such a culture, alternative solutions to problems are not considered. Since there is no choice, the risk of errors is higher. An employee's career and progress are conditioned by the employee's ability to follow the main line of managers.
Tab. 1 Results of the evaluation of organizational culture
| Evaluation of organizational culture |
|---|
| Medical facility |
| State |
| Non-state No. 1 |
| Non-state No. 2 |
Legend: %=relative frequency, 95% CI=confidence interval
The organizational culture in this state organization is structured and emphasizes control. The work is managed formally. Similar are the results of the survey by Ribeliene et al. (2019). In the group of nurses and midwives (n=233), they demonstrated the dominance of hierarchical organizational culture (36.7%) and market culture (27.8%). These cultures were named by the authors as so-called "company glue" despite the fact that respondents preferred clan and adhocratic organizational culture (p<0.05). Comparable results were also published by Vegro et al. (2016). Traczyńska, Kunecka, (2018) demonstrated the dominance of a hierarchical organizational culture in a group of nurses (n=122) using the OCAI questionnaire method. They published conclusions that this type of culture is governed by rigid rules, high specialization, separation of identity and responsibility. In organizations with this type of culture, all actions are "dictated." The goal of this type of culture is "control strengthens efficiency." Success is achieved on the basis of reliable planning and low costs. On our file, this type of culture was identified in a state health facility. We are of the opinion that the organizational culture in these types of hospitals is specific in the normative and value area. Dramatic differs from the type of cultures in NGOs. The disadvantage of this type of culture is forcing conformity, rejecting solutions from people who propose innovative solutions (Sulkowski, 2013, Buchelt, 2017, Jończyk, 2016). The signs of three organizational cultures (hierarchical, clan and market) were present in the non-state medical institution No. 1. Respondents preferred clan culture (26.6%; CI95% = 24.5–28.9). The organization's attention was focused on the cooperation of all employees, which resulted in joint responsibility. The employees were one big family. A healthcare facility is held together and success is achieved through a friendly approach and care for employees. It promotes teamwork, cohesion and morale. The perception of adhocratic culture is also significantly lowest in this case (12.7%; CI95% = 10–15.2). It follows from the above that there is a lack of creativity and flexibility. Winasih et al. (2015) investigated the impact of adhocratic organizational culture on the quality of services provided. They found that innovation, risk, attention to detail, orientation to results and to the team are determinants of service quality. They demonstrated the positive impact of adhocratic organizational culture on the quality of services provided. Clan culture was prevalent in non-state health facility No. 2 (30.8%; CI95% = 27.7–33.9). From the point of view of the respondents, it was also a highly preferred culture. This non-governmental medical facility is characterized by a friendly atmosphere, and the staff here also felt like family members. The atmosphere in this organizational culture is comparable to Hulk's (2024) characterization. The author states that the clan organizational culture creates synergy between employees and the goals of the organization. The type of organizational culture can have an impact on the job satisfaction of employees. San, Hyun (2009) tested whether specific types of culture are related to higher job satisfaction. They recommend that managers pay more attention to maintaining employee satisfaction, thus reducing the risks of employee turnover. In the healthcare sector, we also encounter poor organizational cultures or their absence. Facilities without an organizational culture are exposed to risks that are difficult to resist. They are seen as organizations without vision, entity and variables that would guarantee its prosperity. It is recommended that they undergo a change process.
Conclusion
Healthcare facilities are exposed to the influence of a large number of factors of the external environment, which evoke the need to change the organizational culture. The number of evidences of the need for change is high, especially abroad. We are of the opinion that the types of organizational cultures in Slovakia and their preference may be conditioned by traditions, customs and conformity of management. The risk of changing management culture is resistance. We recommend early prevention of resistance, in the form of preventive clarification of organizational values, by defining a clear organizational vision and mission of the organization. Of the examined types of organizational cultures, adhocratic culture motivates us for further research. Effective leadership in an adhocratic culture that is innovative, visionary and unafraid to take risks is absent in the service management system in the healthcare sector.
Author: prof. PhDr. Mária Kilíková, PhD., MPH VŠZ and SP St. Alžbety v Bratislava, n.o., Detached workplace bl. Sáry Salkaházi Rožňava ORCID: 0000-0001-5248-835X
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